影响中国两个地区综合医院结核病服务整合的因素：一项定性研究。
Factors influencing integration of TB services in general hospitals in two regions of China: a qualitative study.
机构信息
The Chinese University of Hong Kong, 2/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China.
出版信息
BMC Health Serv Res. 2012 Jan 25;12:21. doi: 10.1186/1472-6963-12-21.
BACKGROUND
In the majority of China, the Centre for Disease Control (CDC) at the county level provides both clinical and public health care for TB cases, with hospitals and other health facilities referring suspected TB cases to the CDC. In recent years, an integrated model has emerged, where the CDC remains the basic management unit for TB control, while a general hospital is designated to provide clinical care for TB patients. This study aims to explore the factors that influence the integration of TB services in general hospitals and generate knowledge to aid the scale-up of integration of TB services in China.
METHODS
This study adopted a qualitative approach using interviews from sites in East and West China. Analysis was conducted using a thematic framework approach.
RESULTS
The more prosperous site in East China was more coordinated and thus had a better method of resource allocation and more patient-orientated service, compared with the poorer site in the West. The development of public health organizations appeared to influence how effectively integration occurred. An understanding from staff that hospitals had better capacity to treat TB patients than CDCs was a strong rationale for integration. However, the economic and political interests might act as a barrier to effective integration. Both sites shared the same challenges of attracting and retaining a skilled workforce for the TB services. The role of the health bureau was more directive in the Western site, while a more participatory and collaborative approach was adopted in the Eastern site.
CONCLUSION
The process of integration identifies similarities and differences between sites in more affluent East China and poorer West China. Integration of TB services in the hospitals needs to address the challenges of stakeholder motivations and resource allocation. Effective inter-organizational collaboration could help to improve the efficiency and quality of TB service.
背景
在中国大部分地区，县级疾病预防控制中心（CDC）为结核病患者提供临床和公共卫生保健服务，医院和其他卫生机构将疑似结核病患者转诊给 CDC。近年来，出现了一种综合模式，即 CDC 仍然是结核病控制的基本管理单位，而指定一家综合医院为结核病患者提供临床护理。本研究旨在探讨影响综合医院结核病服务整合的因素，并为中国结核病服务整合的扩大提供知识。
方法
本研究采用定性方法，在中国东部和西部的两个地点进行访谈。采用主题框架方法进行分析。
结果
东部较繁荣的地点协调程度更高，因此资源分配方法更好，以患者为中心的服务更好，而西部较贫困的地点则较差。公共卫生组织的发展似乎影响了整合的有效性。工作人员对医院治疗结核病患者的能力比 CDC 更强的理解是整合的一个强有力的理由。然而，经济和政治利益可能成为有效整合的障碍。两个地点都面临着吸引和留住结核病服务熟练劳动力的挑战。卫生局在西部地点的作用更具指令性，而东部地点则采取了更具参与性和协作性的方法。
结论
整合过程确定了较富裕的东部和较贫困的西部之间的相似性和差异。医院结核病服务的整合需要解决利益相关者动机和资源分配的挑战。有效的组织间协作可以帮助提高结核病服务的效率和质量。
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